In patients with sarcoidosis, cardiac involvement confers a worse prognosis than in those without cardiac involvement.[4,5] However, prognosis is also dependent on treatment and the extent of cardiac involvement. A study by Yazaki et al showed that patients treated with corticosteroids from the onset of diagnosis had a 5-year survival rate of at least 75%, compared to a 5-year survival rate of 10% in untreated patients. They also showed that survival was related to heart function. Treated patients with left ventricular ejection fraction (LVEF) of 50% or higher had a significantly better 10-year survival rate of 89% as compared to treated patients with LVEF less than 50%, who had a10-year survival rate of 27%.
Results are mixed when comparing the survival of cardiac sarcoid patients who receive cardiac transplants vs those who have received cardiac transplants for other conditions. Akashi et al showed a trend towards lower survival rates after cardiac transplantation in patients with cardiac sarcoidosis vs those without cardiac sarcoidosis. Zaidi et al showed better 1-year posttransplant survival for cardiac sarcoidosis patients compared to noncardiac sarcoidosis patients. Some groups show no differences in postcardiac transplantation between cardiac sarcoidosis patients and noncardiac sarcoidosis patients.[30,33] Furthermore, the use of mechanical circulatory support as bridge to transplantation does not appear to affect survival of cardiac sarcoid patients vs noncardiac sarcoid patients receiving cardiac transplants. Common causes of mortality in cardiac sarcoid patients receiving transplantation include infection, hemorrhagic complications, and acute rejection. Recurrence of cardiac sarcoidosis is uncommon with rates ranging from 0% to 14%.
Am J Clin Pathol. 2020;153(3):294-302. © 2020 American Society for Clinical Pathology